Abstract
Background:
Chest-to-arm tunnelled centrally inserted central catheters (CICCs) are increasingly used in critically ill patients when conventional exit sites are unsuitable, particularly in the presence of tracheostomy or excessive respiratory secretions. However, their anatomical configuration may produce radiographic findings that can raise concern for catheter malposition on routine chest X-ray.
Methods:
We performed a retrospective descriptive case series at a tertiary hospital Vascular Access Team. All patients with a chest-to-arm CICC who underwent chest radiography during 2025 were screened. Patients referred for suspected catheter malposition based on chest X-ray findings were included in the analysis. Catheter position had been confirmed at insertion using intracavitary electrocardiography or ultrasound-based tip location methods.
Results:
During the study period, 47 chest-to-arm CICCs were inserted. Of these, 41 patients underwent chest radiography for reasons unrelated to catheter position assessment. Nine patients were referred to the Vascular Access Team because of suspected catheter malposition on chest X-ray. In two cases, the concern originated from the radiology report, while in seven cases it was raised by the treating clinician after image review. Reported findings included apparent looping, coiling or an abnormal catheter course. All catheters were fully functional, with preserved aspiration and infusion. Ultrasound assessment confirmed correct catheter position in all cases and showed no evidence of kinking, coiling, malposition or other catheter-related abnormalities.
Conclusions:
Chest-to-arm CICCs may have a radiographic appearance, that is difficult to interpret on routine chest radiography and may be mistaken for catheter malposition. Awareness of this configuration and clear communication of the device type may help avoid unnecessary investigations and inappropriate device removal.
Get full access to this article
View all access options for this article.